Abstract
BackgroundMost patients with posttraumatic stress disorder (PTSD) suffer from sleep problems. Concerns have been raised about possible detrimental effects of sleep problems on the efficacy of psychological treatments for PTSD. In this study, we investigated the relation of session‐to‐session changes in PTSD symptoms and sleep, and tested whether sleep problems predicted poorer short‐ and long‐term treatment outcome.MethodsSelf‐reported sleep quality, sleep duration, and PTSD symptoms were assessed weekly in a consecutive sample of 246 patients who received cognitive therapy for PTSD (CT‐PTSD; Ehlers & Clark, 2000), and at follow‐up (mean = 247 days posttreatment). Additionally, moderating effects of medication use and comorbid depression were assessed.ResultsSleep and PTSD symptoms improved in parallel. The relation was moderated by depression: Sleep problems at the start of therapy did not predict improvement in PTSD symptoms during treatment for patients without comorbid depression. Patients with comorbid depression, however, showed less rapid decreases in PTSD symptoms, but comparable overall outcome, if their sleep quality was poor. Residual sleep problems at the end of treatment did not predict PTSD symptoms at follow‐up once residual PTSD symptoms were taken into account.ConclusionsCT‐PTSD leads to simultaneous improvement in sleep and PTSD symptoms. Sleep problems may reduce the speed of recovery in PTSD patients with comorbid depression. For these patients, additional treatment sessions are indicated to achieve comparable outcomes, and additional interventions targeting sleep may be beneficial. For those without comorbid depression, self‐reported sleep problems did not interfere with response to trauma‐focused psychological treatment.
Highlights
(mean change = 15.69) from initial assessment to the end of treatment in the intent-to-treat sample, whereas sleep quality ratings increased by a mean of 21.60 and sleep duration improved by 52 min
4b) suggests that the level of posttraumatic stress disorder (PTSD) symptoms at the start of treatment did not correlate with the degree of improvement in PTSD symptoms across treatment, and the starting level of sleep quality did not correlate with the degree of improvement in sleep quality
PTSD symptoms without sleep item (PDSwos) = Posttraumatic Diagnostic Scale sum scores excluding sleep item. aThe addition of the correlation between the intercepts of PDSwos and sleep quality, r = −0.69, P < .001, contributed significantly to the model fit, ࢞χ 2 = 91.95, ࢞df = 1, P < .001, and this correlation was retained in models 3–5. bThe addition of the correlation between the intercept and slope within PDSwos, r = 0.02, P = .80, and sleep quality, r = −0.07, P = .56, did not significantly contribute to the model fit, and was not retained in the models
Summary
The relation was moderated by depression: Sleep problems at the start of therapy did not predict improvement in PTSD symptoms during treatment for patients without comorbid depression. Patients with comorbid depression showed less rapid decreases in PTSD symptoms, but comparable overall outcome, if their sleep quality was poor. Sleep problems may reduce the speed of recovery in PTSD patients with comorbid depression. For these patients, additional treatment sessions are indicated to achieve comparable outcomes, and additional interventions targeting sleep may be beneficial. Additional treatment sessions are indicated to achieve comparable outcomes, and additional interventions targeting sleep may be beneficial For those without comorbid depression, self-reported sleep problems did not interfere with response to trauma-focused psychological treatment.
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